title: Risks and benefits of prophylactic cyclic parenteral nutrition in surgical neonates.
abstract: BACKGROUND
  Cyclic parenteral nutrition (PN) is used for both the treatment and prevention of parenteral nutrition-associated liver disease (PNALD). Early initiation of prophylactic cyclic PN may not be well tolerated in young neonates. Our objective was to test the hypothesis that prophylactic cyclic PN initiated prior to the onset of hyperbilirubinemia is associated with younger age at initiation, lower bilirubin levels, and similar rates of adverse events compared to therapeutic cyclic PN initiated after established cholestasis in surgical neonates.
  
  
  METHODS
  A retrospective review of infants with gastrointestinal disorders requiring surgical intervention who received cyclic PN 2006-2011 was performed.
  
  
  RESULTS
  Of the 43 infants eligible for analysis, 23 received prophylactic and 20 received therapeutic cyclic PN. Infants in both groups were comparable in demographics, surgical diagnoses, and illness severity. At initiation of cyclic PN, infants with prophylactic cyclic PN were significantly younger in chronologic (P = .003) and postmenstrual age (P = .029). Prophylactic cyclic PN was associated with a significantly lower incidence of hyperbilirubinemia (P = .001), lower maximum conjugated bilirubin (P < .0001), and lower last checked conjugated bilirubin (P = .032) compared to the therapeutic cyclic PN. The incidence of hypoglycemia, hyperglycemia, and hypertriglyceridemia was similar for the 2 groups.
  
  
  CONCLUSIONS
  There may be a potential benefit to initiating cyclic PN prior to the development of hyperbilirubinemia in surgical neonates. Early initiation of prophylactic cyclic PN does not appear to increase the risk for adverse events.
authors.affiliation: T. Hang Nghiem-Rao, Division of Neonatology, Department of Pediatrics, Medical College of Wisconsin, PO Box 1997, 999 N 92 St, Milwaukee, WI 53226, USA. Email: hnghiem@mcw.edu.
authors.forename: T Hang
authors.initials: TH
authors.lastname: Nghiem-Rao
authors.forename: Laura D
authors.initials: LD
authors.lastname: Cassidy
authors.forename: Elizabeth M
authors.initials: EM
authors.lastname: Polzin
authors.forename: Casey M
authors.initials: CM
authors.lastname: Calkins
authors.forename: Marjorie J
authors.initials: MJ
authors.lastname: Arca
authors.forename: Praveen S
authors.initials: PS
authors.lastname: Goday
mesh_terms: D000367:Age Factors; D001663:Bilirubin / Q000097:blood; D002779:Cholestasis / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control / Q000628:therapy*; D005260:Female; D005767:Gastrointestinal Diseases / Q000601:surgery; D006801:Humans; D006932:Hyperbilirubinemia / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control / Q000628:therapy*; D015994:Incidence; D007231:Infant, Newborn; D007232:Infant, Newborn, Diseases / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control / Q000628:therapy*; D007234:Infant, Premature; D008107:Liver Diseases / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control / Q000628:therapy*; D008297:Male; D010288:Parenteral Nutrition / Q000009:adverse effects / Q000379:methods*; D011183:Postoperative Complications / Q000097:blood / Q000453:epidemiology / Q000517:prevention & control / Q000628:therapy*; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors
chemical_list: D001663:Bilirubin
keywords: bilirubin; cholestasis; infant, newborn; liver diseases; neonates; parenteral nutrition